Citation Nr: 0202027 Decision Date: 03/01/02 Archive Date: 03/05/02 DOCKET NO. 01-08 911 ) DATE ) ) THE ISSUE Whether clear and unmistakable error (CUE) exists in a Board of Veterans' Appeals (Board) decision dated March 26, 1987. (The issue of entitlement to an evaluation in excess of 10 percent for bilateral chondromalacia during the period from June 1, 1986 to January 19, 1994, will be the subject of a separate decision of the Board.) REPRESENTATION Moving Party represented by: Disabled American Veterans ATTORNEY FOR THE BOARD A. Pitts, Associate Counsel INTRODUCTION The Moving Party had active service from January 1980 to April 1984. In September 2001, the Moving Party, through his representative, filed a statement in lieu of VA Form 1-646, Statement of Accredited Representative in Appealed Case, which is construed as a motion for review on grounds of CUE of the Board of Veterans' Appeals decision dated March 26, 1987 (Motion). FINDINGS OF FACT 1. In a March 26, 1987 decision, the Board denied the Moving Party's appeal of a March 1986 rating decision reducing a combined 20 percent evaluation for right and left knee disabilities to 10 percent (which reduced evaluation was characterized in an implementing rating decision of June 1986 as separate evaluations of 10 percent for the right knee disability and noncompensable for the left). 2. The Moving Party has not pointed to an error that manifestly changed the outcome of the March 26, 1987 Board decision. CONCLUSION OF LAW The March 26, 1987 decision of the Board, did not contain clear and unmistakable error. 38 U.S.C.A. §§ 5109A, 7104, 7111 (West Supp. 2001); 38 C.F.R. §§ 20.1400, 20.1403 (2001). REASONS AND BASES FOR FINDINGS AND CONCLUSION i. Background In March 1986, the RO issued a rating decision proposing the reduction of a combined evaluation for the Moving Party's right and left knee disabilities from 20 to 10 percent. The rating decision and separate notice thereof were provided to the Moving Party in March 1986. He filed a notice of disagreement with this rating decision subsequently in March 1986. Pursuant to the regulation governing rating reductions, 38 C.F.R. § 3.105(e) (1985), the RO issued in June 1986 a rating decision in which the reduced combined evaluation was made effective as of June 1, 1986. The June 1986 rating decision characterized the reduced combined evaluation as one comprised of a 10 percent rating for the right knee disability and a noncompensable rating for the left. The Moving Party perfected his appeal to the Board by filing a VA Form 9, Appeal to Board of Veterans' Appeals, later in June 1986. The Board issued a decision on the appeal on March 26, 1987. The Board determined that evaluations in excess of 10 percent and noncompensable, respectively, for the right and left knee disabilities from June 1, 1986 were not warranted by the evidence of record. Thus, the Board upheld the disability evaluation proposed by March 1986 rating decision (as implemented by the rating decision of June 1986). While the Board characterized the issue as "entitlement to an increased evaluation" the Board took note of the reduction and considered the propriety of the current evaluation. It did not explicitly consider the provisions of 38 C.F.R. §§ 3.105, 3.344 (2001) referable to rating reductions. At the time of the March 26, 1987 Board decision, pertinent evidence of record included the Moving Party's service medical records. These showed that the Moving Party had been diagnosed with, and treated for, chondromalacia of the right patella and loose body, right knee. He was admitted to the United States Naval Hospital in Newport, Rhode Island in July 1983 for surgery, remaining there for one week. His diagnoses and treatment are described in a Medical Board report dated in October 1983. A lateral "retinacular release" was performed, and subsequently, a medial arthrotomy and shaving of the entire medial patellar facet, which was noted to have an extremely irregular and abnormal degree of chondromalacia. A small cartilaginous loose body was also found and removed. At the conclusion of his hospital stay, the Moving Party was found to be fully ambulatory and not limping and his surgical wounds to be healing well. He was observed to have minimal retropatellar crepitus on the right side but no right knee effusion. His right knee range of motion was "approximately 0 degrees extension to approximately 150 degrees of flexion." His discharge diagnoses were chondromalacia, medial patellar facet, right knee and loose body, right knee. The Medical Board recommended in an October 1983 report that because he was still convalescing from the surgery, he be given six months of limited duty ashore "not to include long standing, running, jumping or physical fitness testing" and that he undergo regular physical therapy. In December 1983, the question of the Moving Party's fitness for duty was referred to the Physical Evaluation Board. A report prepared in January 1984 indicates that the Moving Party was given regular physical therapy for his right knee from August 1983 to January 1984. His initial range of motion in the right knee, measured in August 1983, was 20-85 degrees. Later in August 1983, this range of motion had increased to 10-110 degrees. At the end of the course of therapy, it was reported that the Moving Party displayed right knee range of motion "lack[ing] less than 5° to full flexion," "full extension," and right knee effusion. In a Notice to Member of Recommended Findings dated in January 1984, the Physical Evaluation Board concluded that the Moving Party had recovered his fitness for duty. The report of the Moving Party's separation examination, conducted in January 1984, notes in addition to the right knee chondromalacia, status post medial arthrotomy, a contusion of the left knee. Treatment records prepared one day before the separation examination document complaints of left knee pain and a diagnosis of left knee chondromalacia. No further treatment of the left knee is reflected in the service medical records. Also included in the claims file at the time of the March 26, 1987 decision of the Board, were records from Goddard Memorial Hospital showing that in September 1984, after having complained of persistent knee pain and a persistent sensation that his knee caps were giving way, the Moving Party underwent right and left knee arthroscopies and a right knee patella shaving. The arthroscopy of the right knee revealed extreme damage to the medial facet of the patella involving loss of a great deal of soft tissue and cartilage. The area was cleaned out and smoothed. The findings resulting from arthroscopy of the left knee were negative except for a small area of chondromalacia on the medial aspect of the patella. The report of a VA examination performed in January 1985 was also of record at the time of the March 26, 1987 decision of the Board. It documents that the Moving Party complained that he was having pain in both knees when climbing stairs or walking short distances. He gave his current occupation as that of truck driver. The examiner identified no instability, locking, or crepitus in the left knee, which was found to be within normal limits. The right knee was observed to display two-plus crepitus but no swelling, inflammation, effusion, instability, or locking. The patella was freely movable. No muscle atrophy was identified. There was minimal crepitus and minimal pain with compression of each patella. The Moving Party exhibited no gait abnormalities. He was able to walk on his heels and toes and to squat normally, but he was observed to do so with obvious discomfort. A well-healed surgical scar on the right knee was noted in the examination report. X-rays of both knees revealed normal bones and soft tissues. The diagnosis rendered for each knee was chondromalacia. In addition, at the time of the March 26, 1987 decision of the Board, the report of a VA examination conducted in January 1986 was on file. It documents that the Moving Party complained of having pain in both knees, especially the right, when he would bend, walk, or engage in other weight bearing and stated that he currently worked in "water works." The examiner found the left knee to be within normal limits, with full range of motion, no crepitus or instability, and normal gait. The right knee, which was observed to have a well-healed surgical scar on the lateral aspect, manifested two-plus crepitus but no swelling, instability, inflammation, locking, or effusion. The patella was found to be freely movable with excellent muscle development and no atrophy. It was reported that the Moving Party declined x-rays. The examination resulted in a diagnosis of bilateral chondromalacia patellae with post-operative residuals in the right knee. The record at the time of the March 26, 1987 decision of the Board also included a letter dated in April 1986 by R. Hawkins, M.D. Dr. Hawkins reported that the Moving Party walked with a normal gait but had marked tenderness with compression of the patellofemoral joint of the right knee. Suprapatellar tenderness of the right knee was also identified. The left knee was assessed as normal. The Moving Party was found to have no ligamentous instability or knee joint effusion. X-ray findings were characterized as within normal limits except for some irregularity of the surface of the right patella where it met the femur; the radiologist's impression was patellofemoral chondromalacia with probable early patellofemoral arthritis of the right knee. Dr. Hawkins observed that the Moving Party had considerable disability which had worsened over the past few years despite aggressive treatment with surgery. The record at the time of the March 26, 1987 decision of the Board also contained documentation of right knee arthroscopy performed in June 1986 at Burbank Hospital. Arthroscopy with arthroscopic abrasion arthroplasty of the patella and synovectomy of the parapatellar region of the right knee was performed. Operative findings of extensive chondromalacia were reported. The post-operative diagnosis was osteoarthritis of the right patella with synovitis. At the time of the Board decision of March 26, 1987, the claims file also contained the report of a July 1986 VA examination. X-rays taken in connection with the examination revealed no change in the knees since January 1985--both the bones and soft tissues appeared normal. The Moving Party stated that he had difficulty with both knees when climbing stairs, squatting, or kneeling and would experience fatigue from these activities. He also complained of constant popping, grinding, and pain in his knees. He gave his current occupation as that of plumber. It was noted that the Moving Party had undergone arthroscopy on his right knee in June 1986--the presence of a scar from the procedure was noted--and was using a cane, experiencing pain, and walking with a marked limp as a result. The examiner reported that the right knee had one-plus crepitus but no apparent swelling, tenderness, effusion, instability, or locking. The right knee range of motion was reported to be between 60 and 0 degrees. It was noted that the patella appeared to be normal but that the quadriceps muscles were possibly weak to some degree. The left knee had one-plus crepitus. Left knee range of motion was reported to be between 0 and 140 degrees. The patella appeared to be normal and freely movable. The examiner reported that no swelling, tenderness, effusion, locking, or instability of the left knee was found, nor muscle weakness or atrophy associated with the left knee. The examination resulted in diagnoses of chondromalacia patellae for the left knee and chondromalacia patellae, post- operative scar, recent arthroscopic surgery, and severe osteoarthritis for the right knee. In two letters dated in June and September, 1986, respectively, that were also of record at the time of the March 26, 1987 decision of the Board, R. Hawkins, M.D., reported that the Moving Party had severe osteoarthritis of the right knee and very similar symptoms in the left knee. He opined that these conditions resulted in great difficulty climbing and descending stairs, squatting, and kneeling. ii. Analysis A decision by the Secretary is subject to revision on grounds of clear and unmistakable error. A request for review of a Board decision for CUE may be initiated by the Board of its own motion or by the claimant. 38 U.S.C.A. § 7111; 38 C.F.R. § 20.1400. If the evidence establishes this error, the prior decision shall be reversed or revised. 38 U.S.C.A. § 5109A. The effective date for an award based on error under the provisions of 38 C.F.R. § 3.105(a) is the date from which benefits would have been payable if the corrected decision had been made on the date of the reversed decision. 38 C.F.R. § 3.400(k) (2001). Under 38 U.S.C.A. § 7111, the Board has been granted for the first time the authority to revise or reverse a prior decision of the Board on the ground that it was based on CUE. A claim requesting review of a Board decision under the new statute may be filed at any time after the decision has been made. This authority applies to any claim pending on or filed after the date of enactment of the statute, November 21, 1997. VAOPGCPREC 1-98, 63 Fed. Reg. 31263 (1998). Motions for review of prior Board decisions on the grounds of CUE are adjudicated pursuant to the Board's Rules of Practice at 38 C.F.R. §§ 20.1400-1411 (2001). Case law concerning the adjudication of claims alleging CUE established prior to the enactment of section 7111 is reflected in these regulations. The motion alleging CUE in a prior Board decision must set forth clearly and specifically the alleged CUE or errors of fact or law in the Board decision, the legal or factual basis for such allegations, and why the result would have been different but for the alleged error. 38 C.F.R. § 20.1404(b). All final decisions of the Board are subject to review under section 7111 except for those that have been appealed to and decided by a court of competent jurisdiction and decisions on issues that have been decided subsequently by a court of competent jurisdiction. 38 C.F.R. § 20.1400(b) (2001). Decisions of the Board are final when issued. 38 C.F.R. § 20.1100 (2001); see 38 U.S.C.A. §§ 7103(a), 7104(a) (West Supp. 2001). For purposes of motions brought under section 7111, a final decision of the Board is defined as one which was appealable under Chapter 72 of Title 38, United States Code, or which would have been so appealable if such provision had been in effect of the time of the decision. 38 C.F.R. § 20.1401(a) (2001). Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board is appealable to the United States Court of Appeals for Veterans Claims (Court) within 120 days from the date of mailing of notice of the decision, provided that a notice of disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402, 102 Stat. 4105, 4122 (1988). The March 26, 1987 decision of the Board was not appealable to the Court. Thus, the March 26, 1987 decision of the Board became final. Under the regulations governing review of Board decisions for CUE, CUE is defined as "[a] very specific and rare kind of error, of fact or law Generally, either the correct facts, as they were known at the time, were not before the Board, or the statutory and regulatory provisions extant at the time were incorrectly applied." 38 C.F.R. § 20.1403(a); see also Oppenheimer v. Derwinski, 1 Vet. App. 370, 372 (1991) (defining CUE as an administrative failure to apply the correct statutory and regulatory provisions to the correct and relevant facts). Disagreement as to how the facts were weighed or evaluated does not implicate the question of CUE. 38 C.F.R. § 20.1403(d); see Thompson v. Derwinski, 1 Vet. App. 251, 253 (1991) (mere misinterpretation of facts does not constitute CUE). The Secretary's failure to fulfill the duty to assist the claimant with the development of his claim does not constitute CUE. 38 C.F.R. § 20.1403(d); see Caffrey v. Brown, 6 Vet. App. 377, 384 (1994). CUE does not include the otherwise correct application of a statute or regulation where, subsequent to the Board decision being challenged, there has been a change in the interpretation of the statute or regulation. 38 C.F.R. § 20.1403(e). To warrant revision of a Board decision on the grounds of CUE, there must have been an error in the Board's adjudication of the appeal which, had it not been made, would have manifestly changed the outcome of the adjudication. In order for adjudicatory error to rise to the level of CUE, it must be error "that when called to the attention of later reviewers compels the conclusion, to which reasonable minds could not differ, that the result would have been manifestly different but for the error." 38 C.F.R. § 20.1403(a); see also Kinnaman v. Derwinski, 4 Vet. App. 20, 26 (1993) (error must be one that would have manifestly changed the outcome at the time that the error was made). If it is not absolutely clear that a different result would have ensued, the error complained of is not CUE. 38 C.F.R. § 20.1403(c); see also Fugo v. Brown, 6 Vet. App. 40, 43 (1993) ("It [CUE] is a kind of error, of fact or of law, that when called to the attention of later reviewers, compels the conclusion, to which reasonable minds cannot differ, that the results would have been manifestly different but for the error."); Russell v.Principi, 3 Vet. App. 310, 313 (1992) (errors that would not have changed the outcome are harmless). Thus, in order to constitute CUE, an error must be one that is manifestly determinative of the outcome of the underlying claim. Review for CUE in a prior Board decision must be based on the record and the law that existed when the decision was made. 38 C.F.R. § 20.1403(b)(1); see also Russell v. Principi, 3 Vet. App. 310, 313-14 (1992), Porter v. Brown, 5 Vet. App. 233, 235-36 (1993) (subsequently-developed evidence may not be considered). The statutory "benefit of the doubt" rule, see 38 U.S.C.A. § 5107 (West 1991 and West Supp. 2001), does not apply to a motion to revise a Board decision on the basis of CUE. 38 C.F.R. § 20.1411(a). In the Motion, the Board decision of March 26, 1987 is challenged for CUE on two separate grounds. The first ground is that the evidence of record at the time that the Board rendered its decision "clearly and undoubtedly" showed disability of both knees, and that at the very least the veteran should have been awarded a separate 10 percent evaluation for disability of the left knee under the provisions of 38 C.F.R. § 4.40. It is asserted in the Motion that evaluations of at least 20 percent for the right knee disability and at least 10 percent for the left were warranted by the evidence. The second ground is that in upholding the evaluations of 10 percent and noncompensable, respectively, for the right and left knee disabilities, the Board ignored the provisions of 38 C.F.R. § 3.344(a) pertaining to the conditions for reducing disability evaluations. Mere disputes as to how the Board evaluated the evidence are not CUE. 38 C.F.R. § 20.1403(d). In contrast, failure to consider evidence of record pertinent to the claim can be grounds for a finding of CUE in a decision of the Board. 38 C.F.R. § 20.1403(a). In the March 26, 1987 decision, the Board discussed in detail each of the evidentiary documents then of record that are cited by the Moving Party's representative in the Motion--as well as other relevant evidence not cited in the Motion. This evidence was all dated in 1986 or thereafter. The representative has not alleged in support of the Motion that the correct facts as they were known at that time were not before the Board when it rendered its March 26, 1987 decision or that the Board failed to consider evidence pertinent to the appeal. See 38 C.F.R. § 20.1403(a). Although the Board decision did not discuss evidence prior to 1986, the Moving Party has not alleged that such failure materially changed the outcome. The Moving Party's allegation that the evidence "clearly and undoubtedly" showed disability in both knees, is contradicted by several medical opinions to the effect that the veteran had no disability in the left knee. In any event, such an allegation constitutes a dispute as to how the evidence was weighed and cannot rise to the level of CUE. The Motion alleges that pertinent regulatory provisions extant at the time of the March 26, 1987 decision of the Board, specifically 38 C.F.R. § 4.40, were incorrectly applied. In this respect as well, the Motion implicates the question of CUE. Id.; see Oppenheimer, 1 Vet. App. at 372. At the time of the challenged Board decision, as now, 38 C.F.R. § 4.40 provided that [disability] of the musculoskeletal system is primarily the inability . . . to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage, and the functional loss, with respect to all these elements. The functional loss may be due to . . . pain, supported by adequate pathology and evidenced by the visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40 (1986) In its March 26, 1987 decision, the Board analyzed the evidence of record dated from 1986, and determined the rating of each disability, in light of the factors described in this regulation. For example, the Board reviewed evidence of functional loss due to pain and weakness contained in the medical documentation of record. The Board discussed the Moving Party's complaints of pain in both knees and a finding of two-plus crepitus in the right knee documented in the report of the January 1986 VA examination; findings of marked tenderness upon compression of the right knee and of irregularity of the surface of the right patella at the junction with the femur (although not of a positive grind test - - a factor included among those enumerated by the representative in the Motion), and a diagnosis of probable early patellofemoral arthritis of the right knee documented in the April 1986 letter by R. Hawkins, M.D., to J. DiFranza, M.D. (a document mischaracterized by the representative in the Motion as one created by Dr. DiFranza). The Board considered the report of the June 1986 arthroscopic surgery performed upon the right knee and the specifics of that surgery (arthroscopy with arthroscopic abrasion arthroplasty of the patella and synovectomy of the parapatellar region), as well as the diagnosis set forth there of traumatic osteoarthritis of the right patella with synovitis; the Moving Party's complaints of difficulty executing certain movements involving use of one or both knees and of constant popping, grinding, and pain in his knees, the clinical observations that the Moving Party had right knee pain because of arthroscopic surgery and that he was walking with a limp and using a cane, and the findings of right quadriceps weakness, one-plus crepitus, and limited range of motion (0 to 60 degrees, see 38 C.F.R. § 4.71, Plate II (1986)) of the right knee, and the assessment of severe osteoarthritis of the right knee documented in the report of the VA examination conducted in July 1986 (which examination report was not among the items of evidence enumerated by the representative in the Motion); and the clinical observations that the Moving Party had difficulty executing movements involving use of one or both knees, the diagnosis of severe osteoarthritis in the right knee (apparently confirmed by x-rays) and of similar symptoms in the left knee (however, with normal x-rays) documented in the statements by R. Hawkins, M.D., dated in June and September 1986. Thus, the Board not only reviewed thoroughly in the challenged decision the evidence of record dated from 1986, considering all relevant medical documents and summarizing their content at length, but also evaluated that evidence in light of the factors set forth in 38 C.F.R. § 4.40. Indeed, with the exception of the documentation of a positive grind test for the right knee in the April 1986 letter by Dr. Hawkins, the detail pertinent to weakness, pain, and functional loss cited in the Board decision embraced and exceeded that cited in the Motion. It is clear that the Board did not explicitly note the applicability of 38 C.F.R. § 4.40. However, given the findings of normal function in the left knee, the provisions of § 4.40 pertaining to functional impairment did not dictate that the left knee disability required a 10 percent evaluation. The Board decision recognized that a 10 percent evaluation was being provided for the right knee, and noted that the range of motion reported in that knee, even during recuperation from surgery, was not so severe as to warrant more than a 10 percent evaluation under diagnostic codes referable to osteoarthritis. See 38 C.F.R. § 4.71a, Diagnostic Codes 5260, 5261 (1986). There was evidence of record to support a conclusion that the veteran did not have functional impairment that required an evaluation in excess of 10 percent for the right knee. There were a number of reports showing that the veteran had mild or nonexistent functional symptoms in the right knee. Therefore, the failure to explicitly consider the provisions of 38 C.F.R. § 4.40, was not outcome determinative. Furthermore, the Board did not apply the provisions of the schedule for rating disabilities in an erroneous manner in assigning the ratings that it did in its March 26, 1987 decision. See 38 C.F.R. § 20.1403(a). CUE in this sense was not committed. The Board correctly applied relevant diagnostic codes in evaluating the Moving Party's knee disabilities and in accordance with the requirements of 38 C.F.R. § 4.40 (1986), considered relevant evidence of pain, weakness, and functional loss as part of that process. The second allegation of CUE involves the Board's failure to apply the provisions of 38 C.F.R. 3.344(a). However, those provisions were, and are, only applicable to ratings that had been in effect for five years or more. Brown v. Brown, 5 Vet. App. 413, 417-18 (1993), Smith v. Brown, 5 Vet. App. 335, 339 (1993); 38 C.F.R. § 3.344(c) (1986). In the instant case, the combined 20 percent evaluation had only been in effect from November 1, 1984 to May 30, 1986. Since the regulation was not applicable, the failure to apply it could not be CUE. For the foregoing reasons, the Board finds that the Moving Party has not demonstrated CUE in the March 26, 1987 decision of the Board. Accordingly, the Motion is denied. ORDER CUE not having been found in the Board decision dated March 26, 1987, the motion is denied. Mark D. Hindin Member, Board of Veterans' Appeals IMPORTANT NOTICE: We have attached a VA Form 4597B that tells you what steps you can take if you disagree with our decision. We are in the process of updating the form to reflect changes in the law effective on December 27, 2001. See the Veterans Education and Benefits Expansion Act of 2001, Pub. L. No. 107-103, 115 Stat. 976 (2001). In the meanwhile, please note these important corrections to the advice in the form: ? In the section entitled "Appeal to the United States Court of Appeals for Veterans Claims," you are no longer required to file a copy of your Notice of Appeal with VA's General Counsel. ? In the section entitled "Representation before VA," you no longer need to have filed a "notice of disagreement ... that led to the decision the Board has just reviewed for CUE ... on or after November 18, 1988" as a condition for an attorney-at-law or a VA accredited agent to charge you a fee for representing you.